单孔胸腔镜治疗281例老年肺磨玻璃结节患者分析  

Analysis of 281 Elderly Patients with Pulmonary Ground-glass Opacity Treatment by Single-port Thoracoscopy

作　　者：苏雷[1] 张毅[1] 高艳[2] 魏兵[3] 李元博[1] 钱坤[1] 王雷明[4] 王腾腾 魏秀芹[5] Su Lei;Zhang Yi;Gao Yan(Department of Thoracic Surgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]国家老年疾病临床医学研究中心-国家老年肺结节多学科诊疗联盟、首都医科大学宣武医院胸外科,北京100053 [2]国家老年疾病临床医学研究中心-国家老年肺结节多学科诊疗联盟、首都医科大学宣武医院放射科,北京100053 [3]国家老年疾病临床医学研究中心-国家老年肺结节多学科诊疗联盟、首都医科大学宣武医院呼吸与重症医学科,北京100053 [4]国家老年疾病临床医学研究中心-国家老年肺结节多学科诊疗联盟、首都医科大学宣武医院病理科,北京100053 [5]国家老年疾病临床医学研究中心-国家老年肺结节多学科诊疗联盟、首都医科大学附属北京康复医院内镜中心,北京100144

出　　处：《医学研究杂志》2021年第9期27-31,37,共6页Journal of Medical Research

基　　金：国家重点基础研究发展计划(“973”计划)项目(2011CB510100)。

摘　　要：目的分析单孔胸腔镜治疗老年肺磨玻璃结节(ground-glass opacity,GGO)患者的临床资料及病理结果。方法对笔者医院2017年1月~2019年12月行单孔胸腔镜手术治疗、年龄>60岁的老年GGO患者281例的临床资料进行回顾性研究。结果281患者的平均年龄为67.00±5.30岁,其中男性患者83例(29.5%),女性患者198例(70.5%)。190例(67.6%)伴有高血压、糖尿病、吸烟、冠心病、COPD等。胸部CT扫描发现,GGO最大径均值为13.31±7.50mm。平均观察时间为13.48±23.30个月。术式为肺叶切除术88例(31.3%)、亚肺叶切除术193例(68.7%)。手术平均用时为162.61±63.50min,平均术中出血量为53.68±29.60ml。51例(17.6%)术后出现心脑血管、肝功能损害等术后并发症,无围术期死亡病例。术后病理报告:30例(10.7%)为良性GGO病变、75例(26.7%)为浸润前期病变、65例(23.1%)为微浸润腺癌、111例(39.5%)为浸润期肺腺癌。平均住院日为10.93±3.60天。男性患者(P=0.024)、肺叶切除术式(P=0.000)、影像学表现为Ⅲ~Ⅳ型GGO的患者(P=0.036)、浸润期病变患者(P=0.009)是超过平均住院日的主要因素。结论具备Ⅱ型GGO以上特征或最大径10mm以上的GGO是预判老年早期肺癌的重要影像学特征。单孔胸腔镜下的亚肺叶切除是治疗以GGO为影像学表现的老年早期肺癌患者首选的治疗手段。Objective To analyze the clinical data and pathological results of single-port thoracoscopy in the treatment of elderly patients with ground-glass opacity(GGO).Methods A retrospective study was conducted on the clinical data of 281 patients with GGO who were treated with single-port thoracoscopic surgery in our hospital from January 2017 to December 2019.Results The average age of the 281 patients was 67.00±5.30 years,of which 83 were male patients(29.5%)and 198 were female patients(70.5%).There were 190 cases(67.6%)with hypertension,diabetes,smoking,coronary heart disease,COPD.The average maximum diameter of GGO found on chest CT scan was 13.31±7.50mm.The average observation time was 13.48±23.30 months.The surgical procedures were 88 cases(31.3%)of lobectomy and 193 cases(68.7%)of sublobectomy.The average operation time was 162.61±63.50min,and the intraoperative blood loss was 53.68±29.60ml.51 cases(17.6%)had postoperative complications such as cardio-cerebrovascular,liver dysfunction,etc.There were no perioperative deaths.In the postoperative pathology report,30 cases(10.7%)were benign GGO lesions,75 cases(26.7%)were pre-invasive lesions,65 cases(23.1%)were minimally invasive adenocarcinoma,and 111 cases(39.5%)were invasive adenocarcinoma.The average hospital stay was 10.93±3.60 days.Male patients(P=0.024),lobotomy type(P=0.000),patients with imaging manifestations of typeⅢtoⅣGGO(P=0.036),and patients with invasive lesions(P=0.009)were the main factors of prolonged hospital stay.Conclusion GGO with features above typeⅡor GGO with a maximum diameter greater than 10 mm is an important imaging feature for predicting early-stage lung cancer in the elderly.Single-port thoracoscopic sublobectomy is the preferred treatment for the elderly patients with early stage lung cancer with GGO imaging manifestations.

关 键 词：老年患者 磨玻璃肺结节 影像学特征 单孔胸腔镜 术后病理 

分 类 号：R655.3[医药卫生—外科学]